Provider Demographics
NPI:1275617102
Name:PODIATRIC MEDICINE AND SURGERY OF FAIRFIELD COUNTY
Entity Type:Organization
Organization Name:PODIATRIC MEDICINE AND SURGERY OF FAIRFIELD COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:P
Authorized Official - Last Name:KASSARIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:203-340-2777
Mailing Address - Street 1:49 LONDONDERRY DR
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-3508
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:49 LONDONDERRY DR
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-3508
Practice Address - Country:US
Practice Address - Phone:203-340-2777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000813213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty